| NPI | 1962852590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A187853) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301506172) |
| 207R00000X Internal Medicine (Licence: FL ME146086) | |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MI 4301110463) | |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2024-12-02 |